Mental illnesses are complicated. They result from an interplay between our genetics and other biological factors (e.g. brain chemicals, hormones), our environment (e.g. supports, life experiences) and our psychological makeup (e.g. coping skills, personality characteristics). When left untreated or undertreated, disorders like depression can become chronic illnesses that may ultimately be resistant to treatment, causing high levels of disability and suffering.
We know that an early, accurate diagnosis and rapid, appropriate treatment, personalized to each individual, is critical for recovery from mental illness. But the lack of access to high-quality mental healthcare has become the norm in Canada. The majority of Canadians struggling with a mental illness, regardless of the severity, don’t have timely access to a primary care practitioner (PCP) to treat them. Even those with the most severe symptoms and functional impairment can’t get the specialized help they need.
As with mental illness, the factors that have led our mental healthcare system down this dire path are multifactorial.
Delays in access to appropriate (or any) care, inadequate physician training, barriers to collaboration, healthcare system stigma (including amongst mental healthcare practitioners), the lack of standards and dated guidelines, and the lack of technology at the point-of-care are some of the factors contributing to our chronically stressed, teetering-on-the-brink, mental healthcare system.
Over the last few years, news outlets and social media have been highlighting the burden of mental illness, especially as fears of a post-pandemic tsunami of mental illness grew. Sadly, those fears have been realized and, unsurprisingly, just talking about the broken system has not led to viable solutions. The pandemic has only made a critical situation worse.
The mental healthcare system has been under-funded, poorly organized, bureaucracy-centred (rather than patient-centred), unscientific and barrier-riddled for so long, it is irreparably broken. Money alone cannot fix the inadequate care we currently deliver.
Governments appear to have woken up to the urgent need to invest in mental healthcare, but at the same time, they are conflating substance use disorders (especially the opioid crisis) with mental illness. Mental illness and addiction frequently co-occur, but not always. A mounting death toll, especially of so many young people, has appropriately driven governments to act. However, while giving citizens access to a clean drug supply may keep users alive, that won’t treat their mental illness, which could help to break the cycle of addiction. Funneling financial resources towards addiction is important, but not the whole answer, and certainly not the answer to what ails our mental healthcare system. The system needs innovative solutions.
The lack of healthy, skilled practitioners is another critical challenge that money alone can’t solve. Pre-pandemic, clinician burnout was already extremely high. This might explain at least some of the lack of compassion experienced by patients, families and practitioners, when interacting with the mental healthcare system.
The pandemic forced healthcare practitioners to work in chaotic and dire circumstances for more than two years. Initially, just going to work meant putting their staff, their families and their own lives at risk. The politicization of COVID heightened the risks, and the stress, because some patients refused to mask, get vaccinated, or respect the vulnerabilities of others. It’s no wonder nearly 60% of physicians report a high level of burnout and professional dissatisfaction. Nearly 50% are planning to scale back their patient care hours. practitioners need innovative solutions.
The situation is dire, so there should be no sacred cows when confronting our crumbling mental healthcare system. Medicine has traditionally moved at a glacial pace; however, the pandemic has shown the world that when facing an aggressive, wide-spread health threat, leaders can come together and save lives. We must demonstrate the same determined, courageous leadership when facing our mental healthcare crisis, as the personal and economic costs of untreated or under-treated mental illness are not sustainable.
Solving our mental healthcare crisis requires us to provide better support for those who provide mental healthcare to more Canadians than any other group – PCPs. Innovative technology solutions must be scalable, financially-sustainable, easy to employ, and rooted in science.
To create and employ innovative solutions, especially in Canada’s politically-charged, “faux one-tier” healthcare environment, brave government leaders must “grasp the nettle” and openly partner with industry. Healthcare practitioners must collaborate and do better when it comes to training new clinicians. Canadians must educate themselves, use critical thinking to evaluate their “news feeds” and demand better.
Mercifully, gone are the days when a mentally ill loved one was locked away, sometimes permanently. Yet, far too many people are still not receiving appropriate care – care that should be readily available in a rich country like Canada. It is possible to improve mental health outcomes by supporting our PCPs – with the remuneration, education, standards of care and innovative technology necessary to provide high-quality, evidence-informed care. Doing so will create more competent, confident, and compassionate practitioners, who are truly at the core of a healthy, resilient and responsive healthcare system.
This blog post is part of a series looking at the state of our mental healthcare system and ways we can create sustainable change to improve quality and outcomes for anyone impacted by mental illness.
Improving access to high-quality mental healthcare needs to include much better support for our primary care practitioners.
The root causes of a mental illness are complex, so too are the causes underlying our ailing mental healthcare system. Determined, courageous leadership and bold action are needed.
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